Received on _____________________(date)

at _____________________(time)
by __________________ (initials)
Residential Lease Application
Each occupant and co-applicant 18 years or older must submit a separate application

Property Address: _________________________________________________________

Anticipated Move in Date:___________________ Monthly Rent:___________
Security Deposit:_________________

Applicant was referred to Landlord by:

□ Real Estate Agent _______________________________________________
□ Newspaper □ Sign □ Internet □ other__________________________

Applicant’s name (First, Middle, Last) ________________________________________

Is there a co-applicant? □ yes □ no
(if yes, co-applicant must submit a separate application)

Applicants former last name (maiden or married) ________________________________

E-mail: ________________________________ Home Phone______________________

Work Phone: ___________________________ Cell Phone:________________________
Emergency Contact Name & No. ____________________________________________

Marital Status ____________________ Citizenship __________________ (country)

Social Security No. _____________________________
Drivers License No ______________________ In _________________ (state)
Date of Birth ______________________ Height _________ Weight________
Eye Color ____________ Hair Color ____________

Name all other persons who will occupy the Property:

Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______
Name: ______________________________ Relationship: ______________ Age______

Applicants current address: _____________________________ apt # _____________

_____________________________________(city, state, zip)
Landlords name: _________________________________________________________
Landlords phones: _________________ (day) _____________________________(night)
_________________(cell) ____________________________(email)
Date moved-in _________________ Move out date _________________ Rent $______
Reason for move_________________________________________________________
Applicants previous address: ____________________________ apt # _____________
_____________________________________(city, state, zip)
Landlords name: _________________________________________________________
Landlords phones: _________________ (day) _____________________________(night)
_________________(cell) ____________________________(email)
Date moved-in _________________ Move out date _________________ Rent $______
Reason for move_________________________________________________________
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 Residential Lease Application concerning _____________________________________________

Applicants current Employer: _____________________________________________

Address: ___________________________________________________________
_________________________________________________________(street, city, state, zip)
Supervisor Name:________________________ Phone:___________________________
Fax: ______________________________ Email:________________________________
Start Date: _______________________Gross Monthly Income_____________________
Position ________________________________________________________________

Applicants previous Employer: ____________________________________________

Address: ___________________________________________________________
_________________________________________________________(street, city, state, zip)
Supervisor Name:________________________ Phone:___________________________
Fax: ______________________________ Email:________________________________
Employed: from _________to __________Gross Monthly Income__________________
Position ________________________________________________________________

Describe other income Applicants wants considered: _____________________________

________________________________________________________________________

Banks Name and Phone at which Landlord may verify good funds for any rent, fee or
deposit: ______________________________________________________________
_____________________________________________________________________

List all vehicles to be parked on the Property:

Type Year Make Model License/State Color

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List all pets to be kept on the Property (dogs, cats, birds, reptiles, fish, and other pets):

Type & Breed ______________ _______________

Name ______________ _______________
Color ______________ _______________
Weight ______________ _______________
Age ______________ _______________
Gender ______________ _______________
Neutered ? Yes No
Declawed ? Yes No
Shots Current? Yes No
Yes No
Will any waterbeds or water-filled furniture be on the Property? □ □
Does anyone who will occupy the Property smoke? □ □
Will Applicants maintain renters insurance? □ □
If Applicant is in the military, is Applicant serving under orders
Limiting Applicants stay to one year or less? □ □
Has Applicant ever:

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 Residential Lease Application concerning ______________________________________

Been evicted? □ □
Been asked to move out by a Landlord? □ □
Breached a lease or rental agreement? □ □
Filed for bankruptcy? □ □
Lost property in a foreclosure? □ □
Had any credit problems? □ □
Been convicted of a crime? □ □
In any occupant a registered sex offender? □ □
Are there any criminal matter pending against any occupant? □ □
Is there additional information Applicants want considered? □ □

Authorization & Representation: Applicant authorizes Landlord and Landlord’s agent,

at any time before, during or after any tenancy, to: (1) obtain a copy of Applicants credit
report; (2) obtain a criminal background check related to Applicant and any occupant;
and (3) verify any rental, employment, or criminal history or verify any other information
related to this application with persons knowledgeable of such information. Applicant
represents that the statements in this application are true and complete. Applicant
understands that providing false or inaccurate information is grounds for rejection and a
breach of any lease.

Notice: Unless agreed otherwise in writing, the Property remains on the market until a
lease is signed and Landlord may continue to show the Property to other prospective
tenants and accept another offer.

___________________________________________ _______________
Applicants Signature Date

For Landlord use: On __________________(date) ,__________________(name/Initials)

Notified □Applicant □ ______________________________

By □ phone □ mail □ fax □ email □ in person ,

that Applicant was □ approved □ not approved

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